Discrepancies in Peripheral Arterial Function Indices Among Healthy Young Black Africans: Findings from Pilot Study Interpreted Using AHA Reference Values

Abstract Background Accumulating evidence points to a rise in the incidence of peripheral arterial diseases (PAD) among young adults in Sub-Saharan Africa (SSA) highlighting the need for assessing peripheral arterial function (PAF) in this demographic. Current research from Asian populations suggests that established cut-off values for diagnosing PAD—using assessment parameters, such as Ankle-Brachial Index (ABI), Toe-Brachial Index (TBI), and Pulse Volume Waveform (PVW)—may not accurately represent population-specific reference values. This study evaluates these parameters in a carefully selected population of healthy young black Africans, using American Heart Association (AHA) reference values for ABI and TBI to assess their agreement in classifying normal and abnormal readings compared to PVW. The results were also analyzed across sex and between the left and right sides. Methods We carefully and systematically recruited 156 healthy black Africans aged 18–35 years with no characteristics indicative of peripheral arterial dysfunction. An automated device that use oscillometry and photoplethysmography, concurrently measured ABI, TBI, and PVW in a controlled environment. The visual comparison and Student’s t test were employed to compare these values with the AHA references. Results Approximately 19.1% ( n = 23) of participants had an ABI < 0.9, and 41.3% ( n = 50) had a TBI < 0.7 in at least one limb, indicating abnormally low peripheral arterial indices according to AHA criteria. The prevalence of ABI < 0.9 was higher in the left leg (17.4%) compared to the right leg (6.6%), and among males (18.7%) compared to females (15.3%). Similarly, TBI < 0.7 was more prevalent in the left leg (33.9%) than the right leg (24.8%), and higher in females (40.4%) than males (28.1%). Notably, 91% of participants with ABI < 0.9 in the right leg and 97% in the left leg had normal (grade A) PVWs, while 97.6% of those with TBI < 0.7 also had grade A PVWs. Conclusion Healthy young black Africans' ABI and TBI values differed between the right and left legs. A significant proportion of individuals classified as abnormal according to ABI had normal PVWs based on AHA criteria. These findings highlight the need to carefully interpret ABI results in young populations and emphasize the importance of concurrent ABI and PVW measurements. Larger studies are warranted to refine population-specific reference ranges and explore right–left differences' physiological and clinical implications.